09-15-20 Three Large Studies: Heart Valves, Shoulders and Intubation
Drs. Lucas Bracero, Ramanjot Kang, Saamia Alam and Eric Zabirowicz
6:00 PM @ Microsoft Teams
• Makkar RR et al. Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. N Engl J Med. 2020 [PubMed]
• Joffe AM et al. Management of Difficult Tracheal Intubation: A Closed Claims Analysis. Anesthesiology. 2019 Oct;131(4):818-829 [PubMed]
• Kang RA et al. Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery. Anesthesiology. 2019 Dec;131(6):1316-1326 [PubMed]
Dr. Bracero reviewed regional blocks and presented the Kang et al article. Superior trunk block was compared with interscalene brachial plexus block for 80 patients undergoing arthroscopic shoulder surgery. They found no significant differences in pain score 24 hours after surgery. However, the superior trunk block resulted in significantly less hemidiagphragmatic paresis (76.3% vs 97.5%).
Dr. Alam gave a concise presentation about the Makkar et al article. This randomized control trial compared 2032 patients assigned to either transcatheter or surgical aortic-valve replacement in terms of death or stroked within 5 years. Moreover, they compared transfemoral vs transthoracic access. They found no significant differences between the TAVR and surgical approaches. However, incidence of death or disabling stroke was higher after TAVR than after surgery in the transthoracic-access cohort. In the discussion, it was noted that TAVR has changed how we treat cardiac care patients. Now the majority of our cases are TAVR.
The final article of the evening (Joffe et al) was about failed intubation and is an important one for our specialty. It was presented by Dr. Kang. This closed claim analysis compared 102 claims during 2000 to 2012 with 93 claims during 1993 to 1999. Although there was a higher proportion of death in the more recent claims, the more recent patients were sicker and had more emergency procedures. There was also an increase in the number of claims for non-operative settings. We discussed the importance of good judgement, having a secondary plan and asking for help during a difficult tracheal intubation.
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